Provider Demographics
NPI:1720214885
Name:MCCARTHY, MARY (OTR)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:MCCARTHY
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3103
Mailing Address - Country:US
Mailing Address - Phone:203-488-4368
Mailing Address - Fax:203-488-5034
Practice Address - Street 1:226 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BRANFORD
Practice Address - State:CT
Practice Address - Zip Code:06405-3103
Practice Address - Country:US
Practice Address - Phone:203-488-4368
Practice Address - Fax:203-488-5034
Is Sole Proprietor?:No
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000626174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist